2005-02-09 CC Packet - Laserfiche WebLink

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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMJDD/YV) - January 5, 2005 PRODUCER (630)324-2500 FAX (630)324-2501 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE T.J. Adams Group, LLC ~,o.;-'poE~;..~H/S CERTIFICATE DOES NC;~~~'i,~~,~~!;~~,~~" 333 E. Butterfield Rd., Suite 500 Lombard, IL 60148 INSURERS AFFORDING COVERAGE INSURED INSURER A: ACE American Insurance Comoanv INSURER 8: Centerville Lions Club INSURER c: Minnesota INSURER 0: INSURER E" COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMEQ ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTJFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I L~TR TYPE OF INSURANCE POLlCY NUMBER P&.~Y J~fn~~\E Pg~~~,~~~~~N LIMITS GENERAL LIABILITY EACH OCCURRENCE , 1 000 000 -,-,- FIRE DAMAGE (Anyone fire) I X COMMERCIAL GENERAL LIABILITY 1 000 000 I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) I 1 000 A HOOG21731936 09/01/2004 09/01/2005 PERSONAL & ADV INJURY , 1 000 000 - GENERAL AGGREGATE I 2 000 000 GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG I 2 000 000 I POLICY nPROJECn LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - (Per accident) I Included in Above ANY AUTO - ALL OWNED AUTOS BODilY INJURY - HDOG21731936 09/0112004 09/01/2005 (Per person) I SCHEDULED AUTOS A X OWNED AUTOS NOT COVERED HIRED AUTOS BODILY INJURY X (Peracddenl) I NON-OWNED AUTOS ..:..:.. - PROPERTY DAMAGE I (Per accident) GA AGE LIABILITY AUTO ONLY - EA ACCIDENT I ANY AUTO NOT COVERED OTHER THAN EA ACC S - AUTO ONLY: AGG S EXCESS LlABILITY EACH OCCURRENCE I - o CLAIMS MADE OCCUR AGGREGATE I - NOT COVERED $ - DEDUCTIBLE I - RETENTION $ I WORKERS COMPENSATION AND I WCSTAT1j. I I OTHER EMPLOYERS' LIABILITY NO I COVERED E L. EACH ACCIDENT I E L DISEASE. EA EMPLOYEE $ E L DISEASE - POLICY LIMIT I DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTfSPECIAL PROVISIONS ProviSions of the policy apply to the Centerville Lions Club for their participation in the Ice Fishing Contest on February 12-13, 2005 (or any other dates during the policy period). City of Centerville and Anoka County Sheriff's Office are additional insured, but only with respect to liability arising out of the use of premises by the Centerville Lions Club and not out of the sole negligence of the said additional insured. PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES. CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LEnER ,IIUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE-ISSUING COMPANY WILL ENDEAVOR TO MAIL City of Centerville ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1880 Main Street BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Centerville, MN 55038 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE d~6~ John E. Adams, c.P.C.U. AL.ov/"\u LO-;:> (7/97) ACORD CORPORATION 1988